JC is a 56 year old male who presents to the clinic after 5 days of worsening pain and swelling in his genital region. He states that he has a fever and at night he has chills and shaking. He denies having these problems before. He had hemorrhoids with banding 3 weeks ago. “I’m a truck driver, this happens to me once in a while”. He has no abdominal pain nausea vomiting, black or bloody stool. He denies dysuria or frequency. He is divorced, heterosexual and works as a truck driver. He admits to having unprotected sex occasionally.
His medical history was positive for kidney stones and hemorrhoids. He has no allergies and is taking no medications. He does not smoke and drinks beer socially on weekends with friends. His family history is significant for his mother who has type 2 diabetes.
Physical examination showed a mildly ill-appearing man that looked uncomfortable. He is awake and alert. His vital signs: Blood pressure of 158/88 mmHg, heart rate of 110, respiratory rate of 20, and temperature of 99.7 degrees. He is 5′10″ and weighs 260 lb. Head, eyes, ears, nose, and throat are normal. Lungs are clear. Heart is tachycardic with a normal s1 and s2 with no murmurs, gallops, and no rub. Abdomen is soft, distended but not tender with normal bowel sounds. His extremities have no edema, and pulses are normal bilaterally.
His genital exam show a diffuse erythema and edema of his scrotum and perineal area, that is very tender to palpation. There are multiple areas of hemorrhagic necrosis involving a large part of the scrotum but not involving the penis. His testicles are normal in size and contour and were not tender. His perirectal area is erythematous, but there was no evidence of fissures, ulcerations, or crepitus.
Laboratory data include a normal hemoglobin and hematocrit and a white blood count to 19,000 k/mm3. His chemistries reveal a sodium of 131 mEq/l and an glucose of 338 mg/dl.
1. What is the diagnosis?
2. What is your differential diagnosis?
3. What are the potential sources?
4. What are the risk factors for developing this condition?
5. What organisms cause this condition?
6. What is the treatment of this condition?
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